Katsura Yoshiteru, Takeda Yutaka, Ohmura Yoshiaki, Sakamoto Takuya, Shinke Go, Katsuyama Shinsuke, Ikeshima Ryo, Kawai Kenji, Hiraki Masayuki, Sugimura Keijiro, Masuzawa Toru, Takeno Atsushi, Hata Taishi, Murata Kohei
Dept. of Surgery, Kansai Rosai Hospital.
Gan To Kagaku Ryoho. 2021 Dec;48(13):2027-2029.
Atezolizumab plus bevacizumab combination therapy is the first cancer immunotherapy that has shown efficacy in the treatment of hepatocellular carcinoma(HCC). We report a case of HCC with recurrent peritoneal dissemination for which atezolizumab plus bevacizumab combination therapy was effective. The patient, a 63-year-old man, underwent transarterial embolization(TAE)for ruptured HCC, and a mass with dissemination on the caudal side of liver S3 was observed. Laparoscopic lateral hepatic resection plus resection of the dissemination plus cholecystectomy was thus performed in September 2019. However, in November 2019, multiple peritoneal dissemination recurrence was observed, and lenvatinib therapy was initiated. In May 2020, PD was observed, and we had switched to sorafenib therapy. However, in October 2020, further tumor growth and rapid increase in tumor markers(AFP 25,668 ng/mL, PIVKA-Ⅱ 64,960 mAU/mL)were observed, and the patient was judged to have PD. Atezolizumab plus bevacizumab combination therapy was initiated in the same month. Subsequently, a CT scan in January 2021 showed a marked decrease in tumor size, indicating PR. The tumor markers have since normalized(AFP 5 ng/mL, PIVKA-Ⅱ 28 mAU/mL). The patient has been treated with atezolizumab plus bevacizumab combination therapy again and is maintaining PR as an outpatient.
阿替利珠单抗联合贝伐珠单抗的联合疗法是首个在肝细胞癌（HCC）治疗中显示出疗效的癌症免疫疗法。我们报告了一例复发性腹膜播散性HCC患者，阿替利珠单抗联合贝伐珠单抗的联合疗法对其有效。该患者为一名63岁男性，因破裂性HCC接受了经动脉栓塞术（TAE），并观察到肝脏S3尾侧有一个伴有播散的肿块。因此，于2019年9月进行了腹腔镜肝外侧切除术加播散灶切除术加胆囊切除术。然而，2019年11月观察到多处腹膜播散复发，遂开始使用乐伐替尼治疗。2020年5月观察到疾病进展（PD），我们转而采用索拉非尼治疗。然而，2020年10月，观察到肿瘤进一步生长且肿瘤标志物迅速升高（甲胎蛋白25,668 ng/mL，异常凝血酶原64,960 mAU/mL），患者被判定为PD。同月开始使用阿替利珠单抗联合贝伐珠单抗的联合疗法。随后，2021年1月的CT扫描显示肿瘤大小显著减小，表明为部分缓解（PR）。此后肿瘤标志物已恢复正常（甲胎蛋白5 ng/mL，异常凝血酶原28 mAU/mL）。该患者再次接受阿替利珠单抗联合贝伐珠单抗的联合疗法治疗，目前作为门诊患者维持PR状态。
